S9

Question 1

Explain the inevitability of priority-setting in healthcare systems

Answer 1

there is a scarcity of resources- demand outstrips supply thus difficult decisions must be made. Must be clear and explicit about what we are trying to achieve and who benefits from public expenditure

Question 2

What is demand driven by regarding priority-setting?

Answer 2

Demographics- aging population, over 65s with long-term conditions, increased incidence and prevalence of cancer

Question 3

What is priority setting?

Answer 3

Priority setting describes the decisions about the allocation of resources between the competing claims of different services, different patient groups or different elements of care. AKA explicit rationing

Question 4

What is rationing?

Answer 4

The effect of priority setting decisions on individual patients- the extent to which patients receive less than the best possible treatment as a result

Question 5

What are the two forms of rationing?

Answer 5

Explicit rationing and implicit rationing

Question 6

What is implicit rationing?

Answer 6

The allocation of resources through individual clinical decisions without the criteria for those decisions being explicit. Thus= open to abuse, lead to inequities and discrimination

Question 7

What are the positives of explicit rationing?

Answer 7

Transparent, accountable, more evidence-based, more opportunities for equity in decision-making

Question 8

What are some disadvantages of explicit rationing?

Answer 8

Very complex patient and professional hostility, heterogeneity of patients and illnesses

Question 9

Describe a range of approaches to resource allocation in healthcare

Answer 9

Rationing system

Question 10

Health economics: what is scarcity?

Answer 10

Need outstrips resources- prioritisation is inevitable

Question 11

Health economics: what is efficiency?

Answer 11

Getting the most out of limited resources

Question 12

Health economics: what is equity?

Answer 12

The extent to which distribution of resources is fair. Giving everyone a share according to their need.

Question 13

Health economics: what is effectiveness?

Answer 13

The extent to which an intervention produces desired outcomes

Question 14

Health economics: what is utility?

Answer 14

The value an individual places on a health state

Question 15

Health economics: what is opportunity cost?

Answer 15

the loss of other treatments when one treatment is chosen- the opportunity cost of the new treatment is the value of the next best alternative use of those resources

Question 16

what is opportunity cost measured in?

Answer 16

benefits foregone

Question 17

What is allocative efficiency?

Answer 17

You are choosing between the many needs to be met (e.g. fund hip replacement or neonatal care)

Question 18

How do you measure costs?

Answer 18

Identify, quantify and value resources needed

Question 19

How do you measure benefits?

Answer 19

Impact on health status, savings in other healthcare resources, improved productivity

Question 20

What is economic evaluation?

Answer 20

Comparison of resource implications and benefits of alternative ways of delivering healthcare. Facilitates decisions so that they are more transparent and fair

Question 21

What are the components to economic evaluation?

Answer 21

Costs to- NHS, whole public sector, patient. Resources saved

Consequences- health state change, other gains e.g. employment

Question 22

What are the types of economic evaluation?

Answer 22

Cost minimisation analysis, cost effectiveness analysis, cost benefit analysis, cost utility analysis

Question 23

What is cost minimisation analysis?

Answer 23

A method of comparing the costs of alternative interventions with the assumption that they have equal outcomes.

Focuses on costs (i.e only the inputs)- cheapest option preferable. Not often relevant as the outcomes rarely equivalent.

Question 24

What is cost effectiveness analysis?

Answer 24

Compares the relative costs and outcomes (effects) of different courses of action

Comparison of drugs/interventions which have a common health outcome e.g. reduction in blood pressure.

Cost per unit outcome-is the extra benefit worth the extra cost